Now that it appears likely that the opt out option will be the form the public option will take, let's be sure that we understand what that means. It means that all states will have the public option. What you say! No, that's not a guarantee, someone for some reason will opt out. I find that highly unlikely and inconsistent with what we've seen.
We can leave aside those states that will take the public option carte blanch and go straight to those states that might consider not taking public health care. What forces will drive them? Fiscal responsibility, and that ever present insurance lobby. Like it or not, there are some politicians out there that truly cannot see that a publicly funded insurance program will save both money and lives. They will convince themselves that they are doing the right thing by opting out of this program. I don't think I need to explain the financial motivation that insurance companies can bring to the table.
Lets approach the question from a different direction. What states are going to opt out? The answer is the Red States, those states which typically deliver up Republican Senators and Representatives, and a reliable block for the Republican Presidential candidate. What do we know about those Red States? Well, for one, we know that they are largest recipients of federal dollars. Year after year, representatives of those states complain about those awful taxes they have to pay, while capturing on average more than the blue states. Giving up a federal gift like public health care doesn't seem likely for these states, based on their past behaviour. Lets not forget that the governors and representatives of those very same states howled about the federal stimulus dollars earlier this year while raking in as many as they could.
Giving it all for the insurance team. The notion that an insurance company might purchase the politicians in a state responsible for decision making on a public option is not inconceivable. They certainly have the money. But think about the deal. We already have good information on those congresspersons purchased by insurance, moving such an operation to the state level would be beyond obvious. Keep in mind that many of these states have only a couple of big carriers. Gifts from Blue Cross across the board would be hard to cover up. It would make for some very good news, for those organizations that would cover it, and would make a clear statement on how politics work in this country that no one could ignore. Frankly, it might be a very good thing. Of course this supposes that the structure of the opt out is that politicians decide. If a state wide referendum is required... well, I think the last paragraph explains what will happen then.
What it really comes down to is how smart the Democrats are in structuring the opt out. It has to be structured in such a way that those responsible for making the decision aren't a small group that can easily be purchased with little evidence. And even then, I would be very surprised if any state really opted out.